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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
Antibiotic Utilization in Medicaid-Enrolled Children: Associations with Medical Complexity
Kathleen D Snow1, Matthew Hall2, Jay G Berry1
1Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, MA.
The Journal of Pediatrics
|August 3, 2026
Summary
Pediatric antibiotic use is high, especially in children with complex chronic conditions (CCCs). These children require targeted antibiotic stewardship interventions to reduce exposure and broad-spectrum antibiotic use.
Area of Science:
- Pediatric pharmacology
- Public health
- Infectious disease epidemiology
Background:
- Antibiotic utilization in pediatric populations is a significant public health concern.
- Understanding patterns of antibiotic prescribing is crucial for effective antimicrobial stewardship.
- Children with complex chronic conditions (CCCs) may have unique antibiotic needs and risks.
Purpose of the Study:
- To characterize current outpatient antibiotic prescribing trends in pediatric Medicaid beneficiaries.
- To identify patient-specific factors, including clinical complexity, associated with high antibiotic use.
- To inform targeted antibiotic stewardship strategies for vulnerable pediatric groups.
Main Methods:
- Retrospective cohort study utilizing the Merative MarketScan Medicaid Database (2023).
- Inclusion criteria: Children aged 0-18 years continuously enrolled in Medicaid.
- Outcomes: Annual outpatient antibiotic prescription fill rates and high utilization (>50 antibiotic days/year); multivariable logistic regression for factor analysis.
Main Results:
- 39.1% of 2.36 million Medicaid-enrolled children received >1 antibiotic prescription in 2023.
- Antibiotic prescription rates increased significantly with medical complexity, from 514/1,000 in healthy children to 2,882/1,000 in those with ≥3 CCCs.
- High antibiotic utilization was linked to younger age, female sex, specific Medicaid eligibility, capitated plans, and increased CCCs.
Conclusions:
- Children with multiple CCCs exhibit substantially higher antibiotic exposure.
- These children also show increased use of broad-spectrum antibiotics.
- Pediatric patients with multiple CCCs represent a key, underrecognized population for antibiotic stewardship initiatives.
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